Is simulation training effective in increasing podiatrists' confidence in foot ulcer management?

Background: Foot ulcers are a frequent reason for diabetes-related hospitalisation. Clinical training is known to have a beneficial impact on foot ulcer outcomes. Clinical training using simulation techniques has rarely been used in the management of diabetes-related foot complications or chronic wounds. Simulation can be defined as a device or environment that attempts to replicate the real world. The few non-web-based foot-related simulation courses have focused solely on training for a single skill or “part task” (for example, practicing ingrown toenail procedures on models). This pilot study aimed to primarily investigate the effect of a training program using multiple methods of simulation on participants’ clinical confidence in the management of foot ulcers. Methods: Sixteen podiatrists participated in a two-day Foot Ulcer Simulation Training (FUST) course. The course included pre-requisite web-based learning modules, practicing individual foot ulcer management part tasks (for example, debriding a model foot ulcer), and participating in replicated clinical consultation scenarios (for example, treating a standardised patient (actor) with a model foot ulcer). The primary outcome measure of the course was participants’ pre- and post completion of confidence surveys, using a five-point Likert scale (1 = Unacceptable-5 = Proficient). Participants’ knowledge, satisfaction and their perception of the relevance and fidelity (realism) of a range of course elements were also investigated. Parametric statistics were used to analyse the data. Pearson’s r was used for correlation, ANOVA for testing the differences between groups, and a paired-sample t-test to determine the significance between pre- and post-workshop scores. A minimum significance level of p < 0.05 was used. Results: An overall 42% improvement in clinical confidence was observed following completion of FUST (mean scores 3.10 compared to 4.40, p < 0.05). The lack of an overall significant change in knowledge scores reflected the participant populations’ high baseline knowledge and pre-requisite completion of web-based modules. Satisfaction, relevance and fidelity of all course elements were rated highly. Conclusions: This pilot study suggests simulation training programs can improve participants’ clinical confidence in the management of foot ulcers. The approach has the potential to enhance clinical training in diabetes-related foot complications and chronic wounds in general.

Comparison and modification of car following models toward a more accurate microscopic simulation parameters reproduction

Traffic safety studies demand more than what current micro-simulation models can provide as they presume that all drivers of motor vehicles exhibit safe behaviours. Several car-following models are used in various micro-simulation models. This research compares the mainstream car following models’ capabilities of emulating precise driver behaviour parameters such as headways and Time to Collisions. The comparison firstly illustrates which model is more robust in the metric reproduction. Secondly, the study conducted a series of sensitivity tests to further explore the behaviour of each model. Based on the outcome of these two steps exploration of the models, a modified structure and parameters adjustment for each car-following model is proposed to simulate more realistic vehicle movements, particularly headways and Time to Collision, below a certain critical threshold. NGSIM vehicle trajectory data is used to evaluate the modified models performance to assess critical safety events within traffic flow. The simulation tests outcomes indicate that the proposed modified models produce better frequency of critical Time to Collision than the generic models, while the improvement on the headway is not significant. The outcome of this paper facilitates traffic safety assessment using microscopic simulation.

Radiotherapy Monte Carlo simulation using cloud computing technology

Cloud computing allows for vast computational resources to be leveraged quickly and easily in bursts as and when required. Here we describe a technique that allows for Monte Carlo radiotherapy dose calculations to be performed using GEANT4 and executed in the cloud, with relative simulation cost and completion time evaluated as a function of machine count. As expected, simulation completion time decreases as 1=n for n parallel machines, and relative simulation cost is found to be optimal where n is a factor of the total simulation time in hours. Using the technique, we demonstrate the potential usefulness of cloud computing as a solution for rapid Monte Carlo simulation for radiotherapy dose calculation without the need for dedicated local computer hardware as a proof of principal. Funding source Cancer Australia (Department of Health and Ageing) Research Grant 614217

A simulation-based training system for surgical wound debridement

A simulation-based training system for surgical wound debridement was developed and comprises a multimedia introduction, a surgical simulator (tutorial component), and an assessment component. The simulator includes two PCs, a haptic device, and mirrored display. Debridement is performed on a virtual leg model with a shallow laceration wound superimposed. Trainees are instructed to remove debris with forceps, scrub with a brush, and rinse with saline solution to maintain sterility. Research and development issues currently under investigation include tissue deformation models using mass-spring system and finite element methods; tissue cutting using a high-resolution volumetric mesh and dynamic topology; and accurate collision detection, cutting, and soft-body haptic rendering for two devices within the same haptic space.

A hybrid simulation framework to assess the impact of renewable generators on a distribution network

With an increasing number of small-scale renewable generator installations, distribution network planners are faced with new technical challenges (intermittent load flows, network imbalances…). Then again, these decentralized generators (DGs) present opportunities regarding savings on network infrastructure if installed at strategic locations. How can we consider both of these aspects when building decision tools for planning future distribution networks? This paper presents a simulation framework which combines two modeling techniques: agent-based modeling (ABM) and particle swarm optimization (PSO). ABM is used to represent the different system units of the network accurately and dynamically, simulating over short time-periods. PSO is then used to find the most economical configuration of DGs over longer periods of time. The infrastructure of the framework is introduced, presenting the two modeling techniques and their integration. A case study of Townsville, Australia, is then used to illustrate the platform implementation and the outputs of a simulation.

Utility of the Mild Brain Injury Atypical Symptoms Scale to detect symptom exaggeration : an analogue simulation study

Brief self-report symptom checklists are often used to screen for postconcussional disorder (PCD) and posttraumatic stress disorder (PTSD) and are highly susceptible to symptom exaggeration. This study examined the utility of the five-item Mild Brain Injury Atypical Symptoms Scale (mBIAS) designed for use with the Neurobehavioral Symptom Inventory (NSI) and the PTSD Checklist–Civilian (PCL–C). Participants were 85 Australian undergraduate students who completed a battery of self-report measures under one of three experimental conditions: control (i.e., honest responding, n = 24), feign PCD (n = 29), and feign PTSD (n = 32). Measures were the mBIAS, NSI, PCL–C, Minnesota Multiphasic Personality Inventory–2, Restructured Form (MMPI–2–RF), and the Structured Inventory of Malingered Symptomatology (SIMS). Participants instructed to feign PTSD and PCD had significantly higher scores on the mBIAS, NSI, PCL–C, and MMPI–2–RF than did controls. Few differences were found between the feign PCD and feign PTSD groups, with the exception of scores on the NSI (feign PCD > feign PTSD) and PCL–C (feign PTSD > feign PCD). Optimal cutoff scores on the mBIAS of ≥8 and ≥6 were found to reflect “probable exaggeration” (sensitivity = .34; specificity = 1.0; positive predictive power, PPP = 1.0; negative predictive power, NPP = .74) and “possible exaggeration” (sensitivity = .72; specificity = .88; PPP = .76; NPP = .85), respectively. Findings provide preliminary support for the use of the mBIAS as a tool to detect symptom exaggeration when administering the NSI and PCL–C.

Numerical simulation of red blood cells’ motion : a review

The micro-circulation of blood plays an important role in human body by providing oxygen and nutrients to the cells and removing carbon dioxide and wastes from the cells. This process is greatly affected by the rheological properties of the Red Blood Cells (RBCs). Changes in the rheological properties of the RBCs are caused by certain human diseases such as malaria and sickle cell diseases. Therefore it is important to understand the motion and deformation mechanism of RBCs in order to diagnose and treat this kind of diseases. Although, many methods have been developed to explore the behavior of the RBCs in micro-channels, they could not explain the deformation mechanism of the RBCs properly. Recently developed Particle Methods are employed to explain the RBCs’ behavior in micro-channels more comprehensively. The main objective of this study is to critically analyze the present methods, used to model the RBC behavior in micro-channels, in order to develop a computationally efficient particle based model to describe the complete behavior of the RBCs in micro-channels accurately and comprehensively

Simulation of phosphine flow in vertical grain storage : a preliminary numerical study

To fumigate grain stored in a silo, phosphine gas is distributed by a combination of diffusion and fan-forced advection. This initial study of the problem mainly focuses on the advection, numerically modelled as fluid flow in a porous medium. We find satisfactory agreement between the flow predictions of two Computational Fluid Dynamics packages, Comsol and Fluent. The flow predictions demonstrate that the highest velocity (>0.1 m/s) occurs less than 0.2m from the inlet and reduces drastically over one metre of silo height, with the flow elsewhere less than 0.002 m/s or 1% of the velocity injection. The flow predictions are examined to identify silo regions where phosphine dosage levels are likely to be too low for effective grain fumigation.

Large eddy simulation of smoke flow in a real road tunnel fire using FDS

Numerical study is carried out using large eddy simulation to study the heat and toxic gases released from fires in real road tunnels. Due to disasters about tunnel fires in previous decade, it attracts increasing attention of researchers to create safe and reliable ventilation designs. In this research, a real tunnel with 10 MW fire (which approximately equals to the heat output speed of a burning bus) at the middle of tunnel is simulated using FDS (Fire Dynamic Simulator) for different ventilation velocities. Carbone monoxide concentration and temperature vertical profiles are shown for various locations to explore the flow field. It is found that, with the increase of the longitudinal ventilation velocity, the vertical profile gradients of CO concentration and smoke temperature were shown to be both reduced. However, a relatively large longitudinal ventilation velocity leads to a high similarity between the vertical profile of CO volume concentration and that of temperature rise.

Application-level simulation for network security

NeSSi (network security simulator) is a novel network simulation tool which incorporates a variety of features relevant to network security distinguishing it from general-purpose network simulators. Its capabilities such as profile-based automated attack generation, traffic analysis and support for detection algorithm plug-ins allow it to be used for security research and evaluation purposes. NeSSi has been successfully used for testing intrusion detection algorithms, conducting network security analysis and developing overlay security frameworks. NeSSi is built upon the agent framework JIAC, resulting in a distributed and extensible architecture. In this paper, we provide an overview of the NeSSi architecture as well as its distinguishing features and briefly demonstrate its application to current security research projects.

Removal of epoxy-attached thin-sections from glass slides by plasma-etching

Thin-sectioned samples mounted on glass slides with common petrographic epoxies cannot be easily removed (for subsequent ion-milling) by standard methods such as heating or dissolution in solvents. A method for the removal of such samples using a radio frequency (RF) generated oxygen plasma has been investigated for a number of typical petrographic and ceramic thin sections. Sample integrity and thickness were critical factors that determined the etching rate of adhesive and the survivability of the sample. Several tests were performed on a variety of materials in order to estimate possible heating or oxidation damage from the plasma. Temperatures in the plasma chamber remained below 138°C and weight changes in mineral powders etched for 76 hr were less than ±4%. A crystal of optical grade calcite showed no apparent surface damage after 48 hr of etching. Any damage from the oxygen plasma is apparently confined to the surface of the sample, and is removed during the ion-milling stage of transmission electron microscopy (TEM) sample preparation.

Numerical simulation of stochastic ordinary differential equations in biomathematical modelling

In this work we discuss the effects of white and coloured noise perturbations on the parameters of a mathematical model of bacteriophage infection introduced by Beretta and Kuang in [Math. Biosc. 149 (1998) 57]. We numerically simulate the strong solutions of the resulting systems of stochastic ordinary differential equations (SDEs), with respect to the global error, by means of numerical methods of both Euler-Taylor expansion and stochastic Runge-Kutta type.

Design of open source framework for traffic and travel simulation

For the evaluation, design, and planning of traffic facilities and measures, traffic simulation packages are the de facto tools for consultants, policy makers, and researchers. However, the available commercial simulation packages do not always offer the desired work flow and flexibility for academic research. In many cases, researchers resort to designing and building their own dedicated models, without an intrinsic incentive (or the practical means) to make the results available in the public domain. To make matters worse, a substantial part of these efforts pertains to rebuilding basic functionality and, in many respects, reinventing the wheel. This problem not only affects the research community but adversely affects the entire traffic simulation community and frustrates the development of traffic simulation in general. For this problem to be addressed, this paper describes an open source approach, OpenTraffic, which is being developed as a collaborative effort between the Queensland University of Technology, Australia; the National Institute of Informatics, Tokyo; and the Technical University of Delft, the Netherlands. The OpenTraffic simulation framework enables academies from geographic areas and disciplines within the traffic domain to work together and contribute to a specific topic of interest, ranging from travel choice behavior to car following, and from response to intelligent transportation systems to activity planning. The modular approach enables users of the software to focus on their area of interest, whereas other functional modules can be regarded as black boxes. Specific attention is paid to a standardization of data inputs and outputs for traffic simulations. Such standardization will allow the sharing of data with many existing commercial simulation packages.

From simulation to emulation : an integrated approach for network security evaluation

We present a virtual test bed for network security evaluation in mid-scale telecommunication networks. Migration from simulation scenarios towards the test bed is supported and enables researchers to evaluate experiments in a more realistic environment. We provide a comprehensive interface to manage, run and evaluate experiments. On basis of a concrete example we show how the proposed test bed can be utilized.

A simulation framework for smart meter security evaluation

The evolution of classic power grids to smart grids creates chances for most participants in the energy sector. Customers can save money by reducing energy consumption, energy providers can better predict energy demand and environment benefits since lower energy consumption implies lower energy production including a decrease of emissions from plants. But information and communication systems supporting smart grids can also be subject to classical or new network attacks. Attacks can result in serious damage such as harming privacy of customers, creating economical loss and even disturb the power supply/demand balance of large regions and countries. In this paper, we give an overview about the German smart measuring architecture, protocols and security. Afterwards, we present a simulation framework which enables researchers to analyze security aspects of smart measuring scenarios.